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Questions to Ask Your Cardiac Care Team
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Pacemakers need to be periodically checked to ensure that they are functioning correctly. Some testing can actually be done over the phone, using a process called transtelephonic monitoring. This testing of the pacemaker may be done every 2 weeks for the first month after pacemaker implantation, then every month or 2 thereafter.

More detailed testing of the pacemaker needs to be done in person. Such tests may be performed twice in the first 6 months after pacemaker insertion and then every 6 months thereafter. Checking the pacemaker at periodic intervals is important because over time the pacemaker's battery will wear down and because there is a small chance that one of the electrical leads implanted in the heart can "fracture" or malfunction.

Special Considerations for Patients with Pacemakers
There are certain special considerations about which persons with pacemakers shoud be aware:

• Certain medications used to control and treat abnormal heart rhythms can affect the ability of the pacemaker to successfully stimulate the heart to contract. Therefore, whenever any such medication (called an antiarrhythmic agent) is begun in patients with pacemakers, the pacemaker functioning may need to be rechecked.
• Electromagnetic noise or interference (such as that generated by certain heavy industrial equipment) may interfere with pacemaker function or may even change the way a pacemaker has been programmed to operate.
• An electric cautery device used during other surgeries can "confuse" the pacemaker, and the pacemaker may mistake the electric impulse generated by the cautery device for the electric impulses generated by the heart itself. Therefore, patients with pacemakers should be sure the surgeon who is to perform the procedure is aware that they have a pacemaker. The surgeon may then consult with a cardiologist about any special steps to take during the surgical procedure.
• Patients with pacemakers should not undergo the imaging procedure known as magnetic resonance imaging or MRI. The strong magnetic fields generated during an MRI procedure can have various effects on the pacemaker. In addition, the presence of any implanted metal object in patients undergoing an MRI is potentially dangerous.
• Cellular phones can interfere with pacemaker functioning. Digital phones are more likely to cause problems than analog phones. Keeping the cellular phone at least 6 inches away from the pacemaker may decrease the chances of problems. Issues regarding cellular phones should be discussed with the patient's heart doctor.
• The walk-though metal detectors used at airports are not generally regarded as posing a significant problem for pacemaker functioning. Although in some older pacemakers such metal detectors may inhibit the pacemaker for one or two heart beats, this usually does not cause any symptoms. Because pacemakers are made of metal, patients should be aware that they are likely to set off the metal detector alarm. Thus, patients planning on traveling should be sure to carry the wallet-sized pacemaker identification card. Patients with pacemakers should be aware that handheld wand metal detectors can cause problems for pacemakers and should not be used near a pacemaker.

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